Register Bal Madhumeh Dattak Yojana Program

Enter Your Full Name*

Enter Child’s Full Name

Enter Timeline (Years/Months) Since When Your Child Is Suffering From Diabetes

Upload Child Birth Certificate

Upload Child Aadhar Card

Upload Latest Medical Reports

(You can upload multiple files up to 20MB)

Upload Parents’ Aadhar Card

Is the Patient’s Parent/Patient a BPL card holder?
NoYes

If Yes, please upload a BPL card

Annual Income of Parents

Enter Parents’ Name

Enter your Email ID*

Enter Patient’s/Parent’s Mobile No

Enter Alternate Mobile No

Occupation

Address

I hereby declare that the information given in this form is true and correct to the best of my knowledge.

Anuyash Aarogya Pratishthan, 202, B. U. Bhandari Hill side I, Baner Road, Pune